Asthma Management-Induced Diabetic Ketoacidosis: A Case Report

Diabetic ketoacidosis (DKA) is an acute, life‑threatening complication of diabetes mellitus, often triggered by infection, missed insulin doses, or physiological stress. Less commonly, medications such as glucocorticoids and repeated short‑acting beta‑agonists (SABAs) may precipitate DKA by exacerbating insulin resistance and promoting gluconeogenesis. We describe a 50‑year‑old diabetic woman who presented during the Hajj season with acute respiratory distress, wheezing, and tachycardia and was initially treated as an acute asthma exacerbation with four consecutive nebulized salbutamol/ipratropium and a methylprednisolone 125 mg IV. Although her breathing improved, persistent tachycardia and progressive hyperglycemia led to further work‑up. She had missed her insulin injections for two days prior to admission. Venous blood gas analysis shortly thereafter revealed a pH of 7.21, elevated lactate, and severe hyperglycemia (random glucose >500 mg/dL), confirming DKA. Initiation of standard DKA management (insulin IV, fluid resuscitation, and electrolyte replacement) resulted in stabilization. This case highlights the risk of rapid metabolic decompensation in vulnerable patients even after a single dose of corticosteroids combined with high-dose SABA therapy and insulin omission. Atypical presentation in early DKA may include respiratory alkalosis and wheezing, which can delay diagnosis. Clinicians must maintain a high index of suspicion for DKA in diabetic patients presenting with unexplained tachycardia, respiratory symptoms, or gastrointestinal signs, especially when corticosteroids or SABAs are administered. Early recognition and prompt initiation of appropriate therapy are essential to prevent morbidity and improve outcomes.